Pleca locītavas artroskopija
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Toms Arcimovičs, MF VI
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Pleca locītavas artroskopija
- 1. 1 Pleca locītavas artroskopija RSU MF VI kursa students Toms Arcimovičs
- 2. 2 Saturs Ievads pleca artroskopijas vēsturē; Pleca locītavas anatomija; Portāli pleca artroskopijai; Diagnostika; Indikācijas; Opereāciju principi.
- 4. 4 Vēsture Dr. Michael Burman – artroskopijas aizsācējs (gūžas, pleca) 1931.gads; Dr. Masaki Watanabe aizsācējs artroskopijas instrumentu modernizēšanā 1950.gads; 1970.gados plašāk pielietojama - Sķiedru optika - TV monitors - Fokusējās uz sporta traumām
- 6. 6 Lielākais kustību apjoms Nav novērojama kaulu stabilitāte Mīksto audu stabilitāte Daudzi ievainojumi ir ar papildus mīksto audu bojājumu Pleca locītavas anatomija
- 7. 7 Portāli pleca artroskopijai Mugur jais port ls[A]- 3 cm lej unē ā ā 1cm medi li no posterolater lā ā ā acromion st ra;ū »Caur 1/3 mugur j m.deltoideus unē ā interv l caur m.infraspinatus unā ā m.teres minor. »Riska strukt ras- mugur j plecaū ē ā apliecoš art rija un aksil rais nervs.ā ē ā Later l pieeja [C] - 2-3 cm later li noā ā ā acromion dist l s da as;ā ā ļ »Pieeja subacromi lai telpai!ā Priekš jais ports [D] – standarta priekšasē port ls 2 cm late li no priekš j acromionā ā ē ā st ra.ū
- 8. 8 Rotatoru manžetes plīsumi Atdures sindroms Pleca locītavas nestabilitāte Glenoīda skrimšļa plīsums Bicepsa tendinīts Adhezīvs kapsulīts Kalcificējoš tendinīts AC locītavas artrīts Diagnostika Indikācijas pleca artroskopijai
- 9. 9 Anamnēze; Fizikāla izmeklēšana - bez apģērba; - Palpācija; - Aktīva, pasīva ROM; - Spēks; - Stabilitāte; Radioloģiskie izmeklējumi; - Rentgenogramma; - Ultrasonoskopija; - Datortomogrāfija; - Magnētiskā rezonanse. Diagnostika
- 10. 10 M.supraspinatus, M.infraspinatus, M.teres minor, M. subscapularis; Kustību, spēku un stabilizāciju; Akūta vai hroniska izpausme; Gados veci cilvēki un sportisti; Sāpes (naktī), samazināts ROM, izteikts vājums. Rotatoru manžetes bojājums
- 11. 11
- 12. 12 Pleca atdures sindroms Subakromionālā telpas saspiedums; »Attīstās iekaisums rotatoru manžetes cīpslās, bursā; Sportisti, gados veci cilvēki; Ceļot subarcromionālā telpa samazinās un izpaužas simptomi; Artroskopiski subakromioplastika
- 14. 14 Bicepsa cīpslas tendinīts Skar bicepsa garās galvas cīpslu »tūska, iekaisums, cīpsla sabiezē; Parasti kopā ar citām pleca pataloģijām; Visbiežāk ar rotatoru manžetes bojājumu »Glenoīda skrimšļa pārāvumu »Pleca nesatbilitāti »Pleca iespieduma sindromu u.c. Artroskopiski – atbrīvo, transosāla piešuj.
- 16. 16 Skrimšļa defekti Glenoīda labrums – skrimslis, nodrošina pleca stabilitāti. »SLAP – superior labrum ant. to post. »Bankarta bojājums Plīsumi parasti asociēti ar traumu vai pleca nestabilitāti. Sūdzības »sāpēs, diskomforta un nestabilitātes sajūta, samazinātu kustību apjomu.
- 17. 17 Bony bankart lūzums Pie priekšējā pleca mežģījuma ~ 56% gadījumu Atkārtota pleca dislokācija ~ 67 % gadījumu Artroskopiski “enkuru tilts” »metode ar labiem rezultātiem, bet ierobežotām indikācijām
- 18. 18 Arthroscopic Latarjet Procedure Pleca dislokācija – mīksto audu traumatisks bojājums; Atkārtoti mežģījumi – kaulu zuduma dēļ; Priekšējo pleca nestabilitāti biežāk rada bankarta plīsums, bony bankart lūzums Operācijas pamatā coracoida transfērs nodrošinot glenoīda priekšējās virsmas balstu.
- 20. 20 Frozen shoulder – adhezīvais kaspulīts Saistaudu iekaisums ap pleca locītavu Pamatmehānisms neskaidrs »Diabēta pacienti »Ilgstoša imobilizācija »Pleca lūzumi, ievainojumi Sāpes pie kustībām, to ierobežojums Neķirurģiski – fizioterapija,NSPL, GK injekcijas Ķirurģiski – artroskopiska kapsulas atbrīvošana
- 22. 22 Pleca locītava - visliekākais kustību apjoms; Pleca stabilitāti nodrošina mīkstie audi; Daudzi ievainojumi ir ar papildus mīksto audu bojājumu ; Multipli bojājumi; Attēldiagnostikas metodes, lai pierādītu; Pleca locītavas artroskopijas indikācijas paplašinās līdz ar tehnikas attīstību - tie vairs nav tikai rotatori! Īsumā par pleca artroskopiju
- 23. 23 “Campbell’s operative orthopaedics” 12 th edition, volume i s. Terry canale, md http://media.masslive.com/entertainment/photo/italy-travel-trip-5-f-gene4jpg-0fe http://www.intechopen.com/books/regional-arthroscopy/shoulder-arthroscopy https://www.clinicalkey.com.db.rsu.lv/#!/search/history%2520of%2520arthrosco http://www.discoveriesinmedicine.com/Apg-Ban/Arthroscope.html http://centralcoastortho.com/patient-education/anatomy-of-the-shoulder/ http://www.howardluksmd.com/sports-medicine/torn-rotator-cuffs-a-common-sh http://millsteinorthopedics.com/shoulder-arthroscopy/ http://morphopedics.wikidot.com/shoulder-joint-impingement-type-syndromes Izmantotā literatūra
- 24. 24 http://www.gamradtortho.com/images/conditionsShoulderInstabilityFig2.jpg http://alfa-img.com/show/shoulder-inflammation.html http://www.sciencedirect.com/science/article/pii/S2255497113000657 http://drmillett.com/dislocated-shoulder-and-shoulder-instability/#prettyPhoto http://www.actaorthopaedica.be/acta/download/2014-1/15-van%20Oostveen%2 http://www.kneeandshouldersurgery.com/shoulder-disorders/biceps-tendonitis.h http://www.clinicalexams.co.uk/bicipital-tendonitis-tendinosis.asp http://drmillett.com/biceps-tendonitis-injury/ http://www.medicalexhibits.com/obrasky/2008/08085_01X.jpg
- 25. 25 VUMEDI.COM
Editor's Notes
- http://media.masslive.com/entertainment/photo/italy-travel-trip-5-f-gene4jpg-0fe505ea98877212.jpg
- Dr Masaki Watanabe began to modify arthroscopic equipment in the 1950’s - Development during subsequent decades produced smaller diameter arthroscopes, higher quality lenses, fibre-optic light sources and the charge coupled device (CCD) camera http://www.intechopen.com/books/regional-arthroscopy/shoulder-arthroscopy https://www.clinicalkey.com.db.rsu.lv/#!/search/history%2520of%2520arthroscopy http://www.discoveriesinmedicine.com/Apg-Ban/Arthroscope.html
- The shoulder complex consists of the glenohumeral, acromioclavicular, and sternoclavicular joints, along with the scapulothoracic articulation. Kauli, saites, muskuļi, somiņa, http://centralcoastortho.com/patient-education/anatomy-of-the-shoulder/
- end ngIf: !TopicCtrl Medical Topic === First Consult Go to: ngIf: contentType === 'BK' ngIf: contentType !== 'BK' Outline end ngIf: contentType !== 'BK' FIRST CONSULT Rotator cuff injury ngIf: FirstConsultCtrl.lastRevised Revised: October 10, 2013 end ngIf: FirstConsultCtrl.lastRevised ngIf: !FirstConsultCtrl.lastRevised Copyright Elsevier BV. All rights reserved. Key points The rotator cuff is composed of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. The muscles serve to rotate the arm and stabilize the humeral head Rotator cuff injuries encompass a spectrum of conditions that affect the muscles, tendons, and bursa around the glenohumeral joint. Injuries include tendinitis, tendinosis, impingement, and tears Tears are stratified by full or partial thickness, and by acute (>3 months) or chronic presentation. In young patients, tears are usually from acute injuries. Most older patients with rotator cuff tears are relatively asymptomatic Suspicion of rotator cuff injury should be high if the patient cannot actively abduct or raise the arm or can only do so with significant pain Consider magnetic resonance imaging (MRI) to rule out a tear in symptomatic patients with acute injury in preparation for early surgical intervention, particularly patients who require full shoulder mobility for employment Otherwise, conservative treatment with rest, physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections is first-line therapy. Conservative treatment may restore range of motion and strength, and eliminate pain even in patients with rotator cuff tears The Neer impingement sign is helpful to evaluate the shoulder for impingement or rotator cuff tear. Place one hand on the posterior aspect of the scapula to maintain it in the anatomic position and use your other hand to take the patient's internally rotated arm by the wrist and place it in full flexion. This maneuver compresses the greater tuberosity against the anterior acromion and elicits discomfort in patients who have a rotator cuff tear or rotator cuff tendinitis The Hawkins impingement sign reinforces a positive Neer impingement sign. Flex the patient's shoulder to 90°, flex the elbow to 90°, and place the forearm in neutral rotation. Support the elbow and then internally rotate the humerus. Pain elicited with this test is indicative of rotator cuff tear or rotator cuff tendinitis Patients with a frozen shoulder will have severe restrictions to both passive and active motion, indicating adhesive capsulitis or calcific tendinitis Deep-seated pain reproduced by passive motion and joint palpation should raise suspicion of glenohumeral osteoarthritis
- http://www.howardluksmd.com/sports-medicine/torn-rotator-cuffs-a-common-shoulder-injury/ http://millsteinorthopedics.com/shoulder-arthroscopy/
- http://www.kneeandshouldersurgery.com/shoulder-disorders/biceps-tendonitis.html https://vimeo.com/60233400 http://www.medicalexhibits.com/medical_exhibits.php?exhibit=13236_03X&query=shoulder%20debrided%20arthoscope%20shaver%20portal%20humerus%20acromioplasty
- http://www.clinicalexams.co.uk/bicipital-tendonitis-tendinosis.asp Orthopaedic tests for bicipital tendinosis: Speed's test: With the patient's elbow completely extended, supinated, and the shoulder flexed forward at 45 degrees, the practitioner palpates the biciptal groove with one hand while resisting active elevation of the patients same arm with the other. Pain within the proximal bicipital grove represents a positive. Yergason's test: This test evaluates the integrity of the transverse humeral ligament. With the patient seated and the elbow flexed at 90 degrees, stabilise the patient's elbow with one hand whilst holding the patient's wrist with the other. Instruct the patient to externally rotate the shoulder, flex the elbow and supinate the wrist whilst resisting this movement. A snapping sound and or pain within the bicipital grove indicate a positive test.
- http://drmillett.com/biceps-tendonitis-injury/
- http://www.gamradtortho.com/images/conditionsShoulderInstabilityFig2.jpg Figure 2a. Bankart lesion with detachment of the glenoid labrum from 3-6 o'clock. 2b: Artists rendition of a suture anchor repair of the labrum. 2c: Bankart tear with scarring of the labrum along the glenoid. The probe is inserted into the tear. 2d: Labrum after mobilization prior to repair. 2e: Suture passage arthroscopically around labrum. 2f: Completed labral repair and anterior stabilization. INDICATIONS FOR SURGERY IN ANTERIOR SHOULDER INSTABILITY Surgery is recommended in a shoulder that has persistent instability and pain despite an adequate period of rest, rehabilitation, and attempted return to full activity. Rarely, surgery may be recommended after a first time dislocation in certain high risk individuals (military, contact athletes, severe labral tearing on MRI scan). It is more common for a surgeon to recommend rehabilitation in most cases. The risk of recurrent instability in young patients (teens/twenties) after a 1st time dislocation is greater than 50%. If a second or third dislocation occurs, it is advisable to have shoulder stabilization surgery to minimize the risk of further damage to the shoulder labrum and bone. In cases of labral tearing without frank dislocation, the exact indications for surgery are less clear. Simply put, if the shoulder has failed 3-6 months of nonoperative treatment and remains painful and unstable with activity, surgery is probably warranted. ARTHROSCOPIC SHOULDER STABILIZATION SURGERY When the patient and physician have agreed that shoulder stabilization surgery is needed and warranted, the surgery is usually performed arthroscopically in the outpatient setting. An interscalene block (regional anesthesia) with or without general anesthesia is performed. Surgery is performed utilizing 3-4 small incisions with the help of the arthroscope. During the surgery, the labrum is visualized and freed from scar so that it can be mobilized into its normal anatomic position. Bioabsorbable suture anchors are then inserted into the glenoid bone; these anchors each have a suture that is used to reattach the labrum back to the bone. Three to four anchors are usually required to reattach labrum to bone in the setting of recurrent anterior dislocation. A sling and cold therapy device are placed in the operating room to use postoperatively. The following figures depict a typical arthroscopic anterior stabilization and labral repair. SLAP lesion – labrum/glenoid separation at the tendon of the biceps muscle Bankart lesion – labrum/glenoid separation at the inferior glenohumeral ligament
- http://drmillett.com/dislocated-shoulder-and-shoulder-instability/#prettyPhoto http://www.actaorthopaedica.be/acta/download/2014-1/15-van%20Oostveen%20et%20al.pdf Sufficient methods have been developed for treating small fractures. Dealing with them is an integrated part in suture anchor refixation of the labrum. 11 In cases of recent fracture, the refixation of the capsulolabral bone unit is performed. In old fractures, resection of the fragment is favored, despite possible risk of chronic instability due to the loss of glenoid support.
- Adhesive capsulitis (AC) is a common disease that affects 3 to 5% of the general population, is more prevalent in females than in males (2:1), has an age of onset from 40 to 60 years of age, and causes pain and limitation in shoulder range of motion http://www.sciencedirect.com/science/article/pii/S2255497113000657
- http://alfa-img.com/show/shoulder-inflammation.html